<!--/弹框-->
<!--添加用户弹框-->
<div class="modal fade" id="addOrUpdateModal" tabindex="-1" role="dialog" aria-labelledby="addroleLabel" data-backdrop="static" data-keyboard="false">
    <div class="modal-dialog" role="document" style="display: inline-block; width: auto;">
        <div class="modal-content">
            <div class="modal-header">
                <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span></button>
                <h4 class="modal-title" id="addroleLabel">添加孩子</h4>
            </div>
            <div class="modal-body">
                <form id="addOrUpdateForm" class="form-horizontal form-label-left" novalidate>
                    <input type="hidden" name="id">
                    <input type="hidden" name="extEvaluation">
                    <div class="panel panel-default">
						    <div class="panel-heading">
						       	基本资料
						    </div>
						    <div class="panel-body">
						    
                    <div class="item form-group">
                       <!--  <label class="control-label col-md-1 col-sm-1 col-xs-12" for="childId">孩子编号: <span class="required">*</span></label>
                        <div class="col-md-4 col-sm-3 col-xs-12">
                            <input type="text" class="form-control col-md-7 col-xs-12" name="childId" id="childId" required="required" placeholder="请输入孩子编号"/>
                        </div> -->
                        
                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="childName">孩子姓名: <span class="required">*</span></label>
                        <div class="col-md-4 col-sm-3 col-xs-12">
                            <input type="text" class="form-control col-md-7 col-xs-12" name="childName" id="childName" required="required" placeholder="请输入用户名"/>
                        </div>
                        
                         <!-- <label class="control-label col-md-1 col-sm-1 col-xs-12" for="inOuter">孩子类型: <span class="required">*</span></label>
                         
                         
                        <div class="col-md-4 col-sm-3 col-xs-12">
                        	  <select name="inOuter" id="inOuter" class="form-control col-md-7 col-xs-12" required="required">
                                        <option value="0" selected = "selected">内部</option>
                                        <option value="1">外部</option>
	                            </select>
                        </div> -->
                        
                    </div>
                    
                    <!-- <div class="item form-group">
                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="childName">孩子姓名: <span class="required">*</span></label>
                        <div class="col-md-6 col-sm-6 col-xs-12">
                            <input type="text" class="form-control col-md-7 col-xs-12" name="childName" id="childName" required="required" placeholder="请输入用户名"/>
                        </div>
                    </div> -->
                    <!-- <div class="item form-group">
                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="nickname">昵称:<span class="required">*</span></label>
                        <div class="col-md-6 col-sm-6 col-xs-12">
                            <input type="text" class="form-control col-md-7 col-xs-12" name="nickName" id="nickname" required="required" placeholder="请输入昵称"/>
                        </div>
                    </div> -->
                    
                     <div class="item form-group">
                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="sex">性别: <span class="required">*</span></label>
                        <div class="col-md-4 col-sm-3 col-xs-12">
                            <ul class="list-unstyled list-inline">
                                <li>
                                    <div class="radio">
                                        <label> <input type="radio" class="square" name="sex" required="required" value="0"> 男 </label>
                                    </div>
                                </li>
                                <li>
                                    <div class="radio">
                                        <label> <input type="radio" class="square" name="sex" required="required" value="1"> 女</label>
                                    </div>
                                </li>
                                <!-- <li>
                                    <div class="radio">
                                        <label> <input type="radio" class="square" name="sex" required="required" value="2"> 秘密</label>
                                    </div>
                                </li> -->
                                
                            </ul>
                        </div>
                        
                        
                         <label class="control-label col-md-1 col-sm-1 col-xs-12" for="birthday">出生日期 <span class="required">*</span></label>
                        <div class="col-md-4 col-sm-3 col-xs-12">
                            <div class='input-group date' id='myDatepicker'>
                                <input type='text' class="form-control" required="required" id="birthday" name="birthday" placeholder="请输入出生日期"/>
                                 <span class="input-group-addon">
                                   <span class="glyphicon glyphicon-remove"></span>
                                 </span>
                                <span class="input-group-addon">
                                   <span class="glyphicon glyphicon-calendar"></span>
                                </span>
                                
                            </div>
                        </div>
                        
                    </div>
                    
                    <!-- <div class="item form-group">
                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="birthday">出生日期 <span class="required">*</span></label>
                        <div class="col-md-6 col-sm-6 col-xs-12">
                            <div class='input-group date' id='myDatepicker'>
                                <input type='text' class="form-control" required="required" id="birthday" name="birthday" placeholder="请输入出生日期"/>
                                 <span class="input-group-addon">
                                   <span class="glyphicon glyphicon-remove"></span>
                                 </span>
                                <span class="input-group-addon">
                                   <span class="glyphicon glyphicon-calendar"></span>
                                </span>
                                
                            </div>
                        </div>
                    </div> -->
                    
                    
                    <div class="item form-group">
                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="mobile">母亲: </label>
                        <div class="col-md-2 col-sm-2 col-xs-12">
                            <input type="text" class="form-control col-md-7 col-xs-12" name="monther" id="monther"  placeholder="请输入母亲姓名"/>
                        </div>
                        <div class="col-md-2 col-sm-2 col-xs-12">
                            <input type="tel" class="form-control col-md-7 col-xs-12" name="mobile" id="mobile"  data-validate-length-range="6,20" placeholder="请输入手机号"/>
                        </div>
                        
                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="phone">父亲:</label>
                        <div class="col-md-2 col-sm-2 col-xs-12">
                            <input type="text" class="form-control col-md-7 col-xs-12" name="father" id="father"  placeholder="请输入父亲姓名"/>
                        </div>
                        <div class="col-md-2 col-sm-2 col-xs-12">
                            <input type="tel" class="form-control col-md-7 col-xs-12" name="phone" id="phone"  data-validate-length-range="6,20" placeholder="请输入手机号"/>
                        </div>
                        
                    </div>
                  <!--   <div class="item form-group">
                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="phone">座机: <span class="required">*</span></label>
                        <div class="col-md-6 col-sm-6 col-xs-12">
                            <input type="tel" class="form-control col-md-7 col-xs-12" name="phone" id="phone" required="required" data-validate-length-range="6,20" placeholder="请输入座机号"/>
                        </div>
                    </div> -->
                    
                    <!--  <div class="item form-group">
                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="cardno">身份证号:<span class="required">*</span></label>
                        <div class="col-md-6 col-sm-6 col-xs-12">
                            <input type="text" class="form-control col-md-7 col-xs-12" name="cardNo" required="required" id="cardno" placeholder="请输入身份证号"/>
                        </div>
                    </div> -->
                    
                    <div class="item form-group">
                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="email">邮箱:<span class="required">*</span></label>
                        <div class="col-md-4 col-sm-3 col-xs-12">
                            <input type="email" class="form-control col-md-7 col-xs-12" name="email" required="required" id="email" placeholder="请输入邮箱"/>
                        </div>
                        
                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="qq">QQ:</label>
                        <div class="col-md-4 col-sm-3 col-xs-12">
                            <input type="text" class="form-control col-md-7 col-xs-12" name="qq" id="qq" placeholder="请输入QQ"/>
                        </div>
                        
                    </div>
                    <div class="item form-group">
                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="address">地址:<span class="required">*</span></label>
                        <div class="col-md-9 col-sm-9 col-xs-12">
                            <textarea  class="form-control col-md-7 col-xs-12" name="address" id="address" required="required" placeholder="请输入地址" rows="8"></textarea>
                        </div>
                    </div>
                     <!-- <div class="item form-group">
                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="father">父亲:<span class="required">*</span></label>
                        <div class="col-md-6 col-sm-6 col-xs-12">
                            <input type="text" class="form-control col-md-7 col-xs-12" name="father" id="father" required="required" placeholder="请输入父亲姓名"/>
                        </div>
                    </div>
                    <div class="item form-group">
                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="monther">母亲:<span class="required">*</span></label>
                        <div class="col-md-6 col-sm-6 col-xs-12">
                            <input type="text" class="form-control col-md-7 col-xs-12" name="monther" id="monther" required="required" placeholder="请输入母亲姓名"/>
                        </div>
                    </div> -->
                   <!--  <div class="item form-group">
                        <label class="control-label col-md-3 col-sm-3 col-xs-12" for="extEvaluation">外部评估:<span class="required">*</span></label>
                        <div class="col-md-6 col-sm-6 col-xs-12">
                            <textarea class="form-control col-md-7 col-xs-12" id="extEvaluation" name="extEvaluation"  required="required" placeholder="请输入外部评估类型"></textarea>
                        </div>
                    </div> -->
                    
                    </div>
                    </div>
                   
						 <div class="panel panel-default">
						    <div class="panel-heading">
						       	医生诊断
						    </div>
						    <div class="panel-body">
								        <div class="item form-group">
								          
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-fych">
					                                   	<input type="checkbox" class="square" id="EXT-fych" name="EXT-fych">  发育迟缓
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-3 col-sm-3 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-naotan">
					                                   	<input type="checkbox" class="square" id="EXT-naotan" name="EXT-naotan">  脑瘫
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-3 col-sm-3 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-zibizheng">
					                                   	<input type="checkbox" class="square"  id="EXT-zibizheng" name="EXT-zibizheng">  自闭症
					                                </label>
					                            </div>
					                        </div>
								            
								             <div class="col-md-3 col-sm-3 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-hanjian">
					                                   	<input type="checkbox" class="square" id="EXT-hanjian" name="EXT-hanjian">  罕见疾病  <span><input type="text" id="EXT-hanjian-Text" name="EXT-hanjian-Text"></span>
					                                </label>
					                            </div>
					                        </div>
		        						</div>
						    </div>
						</div>
                    
                    
                    
                     
						 <div class="panel panel-default">
						    <div class="panel-heading">
						       	内科疾病
						    </div>
						    <div class="panel-body">
								       <div class="item form-group">
										         <!--  <ul class="list-inline">
										            <li class="control-label col-md-2 col-sm-2 col-xs-12">
										              <input tabindex="1" type="checkbox" id="checkbox-inner-1">
										              <label for="checkbox-inner-1">无 </label>
										            </li>
										            <li class="control-label col-md-5 col-sm-5 col-xs-12">
										              <input tabindex="2" type="checkbox" id="checkbox-inner-2" >
										              <label for="checkbox-inner-2">癫痫症 （</label>
										              <input tabindex="2" type="checkbox" id="checkbox-inner-3" >
										               <label for="checkbox-inner-3">服药中:<span><input tabindex="5" type="text" id="text-inner-1"></span></label>
										                <input tabindex="2" type="checkbox" id="checkbox-inner-5" checked>
										                <label for="checkbox-inner-5">未服药 ）</label>
										            </li>
										            <li class="control-label col-md-2 col-sm-2 col-xs-12">
										              <input tabindex="3" type="checkbox" id="checkbox-inner-6">
										              <label for="checkbox-inner-6">心脏病 </label>
										            </li>
										          </ul> -->
										          
										          
										           <div class="col-md-2 col-sm-2 col-xs-12">
							                            <div class="checkbox">
							                                <label for="EXT-none">
							                                   	<input type="checkbox" class="square" id="EXT-none" name="EXT-none">  无  
							                                </label>
							                            </div>
							                        </div>
							                        
							                        <div class="col-md-3 col-sm-3 col-xs-12">
							                            <div class="checkbox">
							                                <label for="EXT-dianxian">
							                                   	<input type="checkbox" class="square" id="EXT-dianxian" name="EXT-dianxian">  癫痫症 （ <input type="checkbox" class="square" id="EXT-fuyao" name="EXT-fuyao">服药中:<span><input tabindex="5" type="text" id="EXT-fuyao-Text" name="EXT-fuyao-Text"></span>
							                                </label>
							                                
							                                 <label for="EXT-noneyao">
							                                    <input type="checkbox" class="square" id="EXT-noneyao" name="EXT-noneyao">未服药 ）
							                                </label>
							                                
							                            </div>
							                        </div>
					                        
					                        		<div class="col-md-3 col-sm-3 col-xs-12">
							                            <div class="checkbox">
							                                <label for="EXT-heartdis">
							                                   	<input type="checkbox" class="square" id="EXT-heartdis" name="EXT-heartdis">  心脏病 
							                                </label>
							                            </div>
							                        </div>
							                        
		        						</div>
						    </div>
						</div>
                    
                    
                    <div class="panel panel-default">
						    <div class="panel-heading">
						       	相关能力
						    </div>
						    <div class="panel-body">
								       <div class="item form-group">
					                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="language">语言:<span class="required">*</span></label>
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-language-none">
					                                   	<input type="checkbox" class="square" id="EXT-language-none" name="EXT-language-none">  无
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-language-low">
					                                   	<input type="checkbox" class="square" id="EXT-language-low" name="EXT-language-low">  差
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-language-exce">
					                                   	<input type="checkbox" class="square" id="EXT-language-exce" name="EXT-language-exce">  构音异常
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-language-norm">
					                                   	<input type="checkbox" class="square" id="EXT-language-norm" name="EXT-language-norm">  正常
					                                </label>
					                            </div>
					                        </div>
					                        
					                    </div>
					                    
					                    
					                     <div class="item form-group">
					                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="listen">听觉:<span class="required">*</span></label>
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-listen-norm">
					                                   	<input type="checkbox" class="square" id="EXT-listen-norm" name="EXT-listen-norm">  正常
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-4 col-sm-4 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-listen-exce">
					                                   	<input type="checkbox" class="square" id="EXT-listen-exce" name="EXT-listen-exce">  异常 ；左耳<input type="text" class="square" id="EXT-listen-left-Text" name="EXT-listen-left-Text">分贝;右耳<input type="text" class="square" id="EXT-listen-right-Text" name="EXT-listen-right-Text">分贝
					                                </label>
					                            </div>
					                        </div>
					                        
					                    </div>
					                    
					                    
					                     <div class="item form-group">
					                        <label class="control-label col-md-1 col-sm-1 col-xs-12" for="look">视觉:<span class="required">*</span></label>
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-look-norm">
					                                   	<input type="checkbox" class="square" id="EXT-look-norm" name="EXT-look-norm">  正常
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-look-exec">
					                                   	<input type="checkbox" class="square" id="EXT-look-exec" name="EXT-look-exec">  异常（ <input type="checkbox" class="square" id="EXT-look-xieshi" name="EXT-look-xieshi">斜视 <input type="checkbox" class="square" id="EXT-look-week" name="EXT-look-week">弱势）
					                                </label>
					                            </div>
					                        </div>
					                        
					                    </div>
					                    
							</div>
					</div>
                    
                    
                    
                    <div class="panel panel-default">
						    <div class="panel-heading">
						       	评估服务
						    </div>
						    <div class="panel-body">
								       <div class="item form-group">
								       		 <label class="control-label col-md-1 col-sm-1 col-xs-12" for="action">动作操作摄影:<span class="required">*</span></label>
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-family-shot">
					                                   	<input type="checkbox" class="square" id="EXT-family-shot" name="EXT-family-shot">  家人自行拍摄
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-company-shot">
					                                   	<input type="checkbox" class="square" id="EXT-company-shot" name="EXT-company-shot">  单位代为拍摄
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-none-shot">
					                                   	<input type="checkbox" class="square" id="EXT-none-shot" name="EXT-none-shot">  不拍摄
					                                </label>
					                            </div>
					                        </div>
								       </div>
								       
								       
								       
								       <div class="item form-group">
								       		 <label class="control-label col-md-1 col-sm-1 col-xs-12" for="course">家长培训课程:<span class="required">*</span></label>
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-course-one">
					                                   	<input type="checkbox" class="square" id="EXT-course-one" name="EXT-course-one">  一次
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-course-two">
					                                   	<input type="checkbox" class="square" id="EXT-course-two" name="EXT-course-two">  二次
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-course-three">
					                                   	<input type="checkbox" class="square" id="EXT-course-three" name="EXT-course-three">  三次
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-course-none">
					                                   	<input type="checkbox" class="square" id="EXT-course-none" name="EXT-course-none">  都不需要
					                                </label>
					                            </div>
					                        </div>
					                        
								       </div>
								       
								       
								       <div class="item form-group">
								       		 <label class="control-label col-md-1 col-sm-1 col-xs-12" for="train">评估后辅导操作课程:<span class="required">*</span></label>
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-train-halfmonth">
					                                   	<input type="checkbox" class="square" id="EXT-train-halfmonth" name="EXT-train-halfmonth">  半个月一次
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-train-month">
					                                   	<input type="checkbox" class="square" id="EXT-train-month" name="EXT-train-month">  一个月一次
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-train-none">
					                                   	<input type="checkbox" class="square" id="EXT-train-none" name="EXT-train-none">  不需要
					                                </label>
					                            </div>
					                        </div>
								       </div>
								       
								       <div class="item form-group">
								       		 <label class="control-label col-md-1 col-sm-1 col-xs-12" for="actionupdate">愿意定期评估动作修正:<span class="required">*</span></label>
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-actionupdate-month">
					                                   	<input type="checkbox" class="square" id="EXT-actionupdate-month" name="EXT-actionupdate-month">  一个月一次
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-actionupdate-twomonth">
					                                   	<input type="checkbox" class="square" id="EXT-actionupdate-twomonth" name="EXT-actionupdate-twomonth">  两个月一次
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-actionupdate-none">
					                                   	<input type="checkbox" class="square" id="EXT-actionupdate-none" name="EXT-actionupdate-none">   不需要
					                                </label>
					                            </div>
					                        </div>
								       </div>
								       
								       <div class="item form-group">
								       		 <label class="control-label col-md-1 col-sm-1 col-xs-12" for="phonereturn">愿意定期疗育电话回访:<span class="required">*</span></label>
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-phonereturn-month">
					                                   	<input type="checkbox" class="square" id="EXT-phonereturn-month" name="EXT-phonereturn-month">  一个月一次
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-phonereturn-twomonth">
					                                   	<input type="checkbox" class="square" id="EXT-phonereturn-twomonth" name="EXT-phonereturn-twomonth">  两个月一次
					                                </label>
					                            </div>
					                        </div>
					                        
					                        <div class="col-md-2 col-sm-2 col-xs-12">
					                            <div class="checkbox">
					                                <label for="EXT-phonereturn-none">
					                                   	<input type="checkbox" class="square" id="EXT-phonereturn-none" name="EXT-phonereturn-none">  不需要
					                                </label>
					                            </div>
					                        </div>
								       </div>
								       
								       <div class="item form-group">
								       	<label class="col-md-12 col-sm-12 col-xs-12" for="monther">教育倡导及咨询：请加入神经平衡疗法--北京家长群。微信号：NDBTSYEH							       </div>
								       
							</div>
					</div>
					
					
                </form>
            </div>
            <div class="modal-footer">
                <button type="button" class="btn btn-default" data-dismiss="modal"><i class="fa fa-close"> 关闭</i></button>
                <button type="button" class="btn btn-success addOrUpdateBtn"><i class="fa fa-save"> 保存</i></button>
            </div>
        </div>
    </div>
</div>
<!--/添加用户弹框-->